Study: Late Night Surgery Twice as Likely to Kill Patients as Daytime Operations
November 29, 2017
Research presented at last summer’s World Congress of Anesthesiologists in Hong Kong revealed a bit of a shocker: patients who undergo surgery at night are more prone to die, compared to those operated on during standard working hours.
In other words, the later your surgery is, the greater the risk.
The findings, according to an in-depth study led by Doctor Michael Tessler and Doctor Ning Nan Wang, of the Anesthesia Department at McGill University in Montreal Canada, surprised more than a few in attendance. They also learned that patients undergoing surgery in late afternoon and evening, also have a higher tendency to die.
Post-operative complication factors have been studied for decades. But the purpose of this particular evaluation was to determine if there is any relationship between patient death rates and times of the day when surgeries occur. The research focused on a single, highly-rated Canadian hospital – Jewish General Hospital in Montreal.
Evidently, night is not the ideal time to be in labor, either. One California study found a 25% greater risk of neonatal death following nighttime deliveries.
The researchers assessed all operations that took place over the previous 5 years, covering the period of April 2010 – March, 2015, that involved general anesthesia. Both emergency and elective cases were included.
The 24-hour day was divided into 3 time-frames: 7:30am to 3:29pm; 3:30 to 11:29pm; 11:30 to 7:29am. The surgical “start time” was considered to be when the first anesthetic was administered to each patient.
The researchers assessed just under 42,000 operations performed on 34,000 patients. (Some patients – such as emergency patients – require more than one procedure) About 10,500 were emergency patients.
Doctors Tessler and Wang discovered that – after making adjustments for patient ages and other relevant factors – those operated on in late afternoons and evenings. were 143% more likely to not survive, and the late night patients were 217% more likely to die, than those operating on during routine daytime hours.
“This study demonstrates that late day and night emergency surgeries are associated with higher mortality. Postoperative, 30-day in-hospital mortality rate should include start time of anesthesia, along with other known variables, as a risk factor.”
Fatigue, Circadian Rhythms and Shift Changes May be to Blame
As for why the afternoon may prove to be a more dangerous time for surgery, there are likely several factors involved. Among them:
Circadian rhythm: The natural circadian rhythm, which governs sleep, brain activity and other bodily functions, dips between 3 pm and 5 pm, which may make it harder for health care professionals to stay on top of complex tasks, such as administering anesthesia.
Fatigue: Many health care workers start their days early and end their shifts right around 3 pm. This end-of-the-day fatigue, or simply their eagerness to get home, could impact their performance on the job.
Shift Changes: Anesthesia teams often change shifts 4 pm-6 pm. This means you may end up with different people caring for you from the start to finish of your surgery. While essential information should be transferred between teams during the shift change, it's a prime situation for mishaps to occur.